The Source for Neurovascular News and Education

August 11, 2020

 

Key Points:

- Study looks at short-term EACA use in aneurysmal subarachnoid hemorrhage treated ACA Before Coiling of Ruptured Saccular Aneurysm with coiling

- EACA had no impact on ischemic or rebleeding

 

In patients with ruptured saccular aneurysms, short-term use of ε- aminocaproic acid (EACA) before endovascular therapy does not appear to affect the likelihood either preinterventional hemorrhage or thromboembolic events but may increase the need for shunt, according to findings published online June 17, 2016, ahead of print in the Journal of Neurosurgery. However, EACA use also has a protective effect against cardiac complications and respiratory insufficiency.

“Randomized clinical trials are required to provide robust clinical recommendations” on this issue, Aaron A. Cohen-Gadol, MD of Indiana University (Indianapolis, IN), and colleagues advise.

The researchers identified 341 consecutive patients who underwent endovascular coiling of ruptured saccular aneurysms between 2000 and 2011 at their institution, examining outcomes based on preprocedural EACA use.

All patients underwent the procedure within 72 hours of admission. Overall, EACA was administered in 146 patients (43%) and withheld in 195 (57%).

Use of EACA did not affect the preinterventional risk of rebleeding or in-hospital thromboembolic events like clinical stroke and pulmonary embolism. It was linked to greater need for shunting but fewer cardiac complications and instances of respiratory insufficiency (table 1).

 

In addition, patients who received EACA had a longer duration of hospital stay than those who did not (median 19 vs 14 days; P < .001). There was no apparent impact of short-term EACA use on Glasgow Outcome Scale score at discharge, 6 months, or 1 year following discharge.

The Endovascular Setting

“To our knowledge,” the investigators write, “this is the first study that specifically assesses short-term EACA use in [aneurysmal subarachnoid hemorrhage] patients undergoing endovascular treatment.”

They note that over the past 3 decades, “the trend for the care of ruptured aneurysms has centered on early intervention, alleviating the need for prolonged antifibrinolytic therapy. However, there still may be a significant time interval between the onset of hemorrhage and definitive intervention in certain situations, particularly when a patient is transferred to a tertiary care center. During this period, maximizing protection from rebleeding is desirable.”

This is where short-term EACA protection comes in, and its use is backed as a “reasonable option” by current American Heart Association and American Stroke Association guidelines “in the setting of an unavoidable delay in aneurysm obliteration during the interim between clinical presentation and definitive [surgical] aneurysm repair,” Dr. Cohen-Gadol and colleagues report.

But as they point out in their paper, thrombotic risk is a concern in the context of aneurysmal subarachnoid hemorrhage, particularly in patients undergoing coiling. The condition itself “potentially creates a prothrombotic and proinflammatory state as indicated by serum markers, such as platelet count, leukocyte count, erythrocyte sedimentation rate, and C-reactive protein levels,” they note. “In addition, thrombotic risks are reported to be higher with endovascular treatment compared with microsurgery.”


Source:

  • Malekpour M, Kulwin C, Bohnstedt BN, et al. Effect of short-term ε-aminocaproic acid treatment on patients undergoing endovascular coil embolization following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2016;Epub ahead of print.

Disclosures:

  • Dr. Cohen-Gadol reports no relevant conflicts of interest.